FIFTY YEARS OF OTOLARYNGOLOGY

L. w. DEAN, M.D.

Professor of OtolaryngoIogy, Washington University School of Medicine

ST. LOUIS,

F IFTY years ago otoIaryngoIogy was in its infancy. During the Iatter part of the nineteenth century Politzer, the

nestor of the otoIaryngoIogica1 profession, was in Vienna. Sir FeIix Semon deveIoped IaryngoIogy in EngIand. In this country, among others, BIake was advancing otoIogy and Bosworth rhinoIaryngoIogy.

At that time otoIaryngoIogy occupied a very insignificant pIace in the curricuIa of our medica schooIs. There was in medica schooIs IittIe or no cooperation between the departments of medicine, surgery, pedi- atrics and otoIaryngoIogy. Perhaps the greatest advance during the past fifty years has been the intimate contact that has developed in our medica schooIs between the other cIinica1 departments and oto- IaryngoIogy. This, together with the reaI- ization that otoIaryngoIogy is onIy a subdivision of medicine and surgery and cannot make progress independent of these, has had much to do with the deveIopment of this speciaIty. Today anatomy, pathoI- ogy surgery, medicine and pediatrics con- stitute the foundation for otoIaryngoIogy.

Undergraduate courses in this subject have become much better. Fewer hours are devoted to the subject than fifty years ago but the time is much better utiIized. Fifty years ago the undergraduate course had as its object to teach the student to treat patients with otoIaryngoIogica1 disorders. The smaI1 number of speciaIists, the sparsely settIed communities, with poor roads and the country doctor, necessitated this.

Today the principa1 function of the undergraduate course is to prepare the student for otoIaryngoIogica1 work during his undergraduate ward service and par- ticuIarIy to form a foundation for his work during his genera1 internship.

MISSOURI

The exigencies of the situation have been met by the great increase in quaIified oto- IaryngoIogists, increase in popuIation, hard surfaced roads, the automobiIe and county hospitaIs.

The graduate work in otoIaryngoIogy in this country fifty years ago was mediocre. At that time Vienna was the mecca for graduate students from the United States and Great Britain. There were a few graduate courses in 0toIaryngoIogy in America, where the whoIe subject was taught in a few weeks. In EngIand there was abundant opportunity to work in out-clinics but there was IittIe systema- tized teaching, and there were very few residencies.

After the WorId War the American OtoIogicaI, RhinoIogicaI and LaryngoIogi- ca1 Society appointed a committee to study undergraduate and graduate teaching of otoIaryngoIogy. This committee functioned for a number of years and aided very much in the deveIopment of otoIaryngoIogy. The American Academy of OphthaImoIogy and OtoIaryngoIogy estabIished a teachers’ sec- tion. This met once a year. AI1 important otoIaryngoIogica1 teaching probIems were debated. This section stiI1 exists, the attendance is Iarge and it has heIped and is stiI1 heIping in the deveIopment of the undergraduate and graduate teaching of this subject.

The greatest influence on the deveIop- ment of otoIaryngoIogy was, and now is, the American Board of OtoIaryngoIogy. It was created in the earIy part of the twenties. Its initiaI membership consisted of two members from the American Otologi- ca1 Society, two from the American Laryngo- logica Association, two from the American Academy of OphthaImoIogy and OtoIaryn- goIogy, and two from the Ear, Nose and

NEW SEHIES VOL. Ll, No. I Dean--0toIaryngoIogy

Throat Section of the American Medical Association. AI1 members serve on the board without remuneration and all are outstanding teachers of otoIaryngoIogy. The purpose of the board is to certificate those otolaryngologists who in their judg- ment are good otolaryngologists. The certificate indicates to the medical profes- sion and the public the proficiency of the holder of the certificate. In order to deter- mine this examinations are held at least twice a year.

A carefu1 study of the credentials of each candidate is made before he is’ admitted to examination. The examination is divided into four parts; clinical, written, didactic and pathological.

Al1 hospitals with residencies in otolaryn- gology and a11 medical schools with gradu- ate courses in otolaryngology have been unconsciously stimulated by the work of the Board and are making efforts to see that their graduates not only meet the requirements of the Board but also pass the examinations. The Board has been an important factor in the deveIopment of graduate teaching of otolaryngology. Over two hundred candidates are examined yearly.

Due to the work of the American Board, the hospitals and medical schools, the graduate teaching of oto1aryngoIogy in the United States has become the best in the world. Courses in the basic sciences of otoIaryngoIogy are given. The purpose of these courses is to prepare the individual for a residency in otolaryngology. In some instances the hospital staff gives to its residents courses in the basic sciences. The otoIaryngoIogists who are educated today are we11 trained. Fifty years ago we had to travel and to work hard both at home and abroad to secure training which was far inferior to that given in all parts of the United States today.

Research work in otoIaryngology in this country is the very best. Mosher, Crow, Proetz, Fenton, Bunch, SchaII, Fursten- berg, Fowler, Hilding and a host of others are aiding in its advance.

The advances in medica education and the research work have made a wonderfu1 change in otoIaryngoIogy in fifty years. Fifty years ago many physicians were genera1 practitioners today, otoIaryngoIo- gists tomorrow. The change was indicated by a new sign hung over the door or printed on the window. Many of these physicians were sprayers of the nose, a procedure which has been almost wholly discarded.

The surgery of otoIaryngoIogy was not deveIoped. Acute suppurative mastoids were drained onIy if the condition of the patient was critical. I know of one promi- nent surgeon in a State MedicaI Society Meeting defending the use of boric drops in the ear over a Iong period for chronic sup- purative otitis media, rather than drainage of the puruIent pocket.

Surgery of the ear, nose and throat devefoped during the earIy part of the Iast fifty years. Much of the groundwork for surgery was laid by Zuckerkundl’s work in the anatomy of the nasal sinuses. This was done during the Iast part of the nineteenth century. The work of Onodi, particuIarIy on the nasa1 sinuses in chiIdren, in I go8, was an important factor. Sir St. Clair Thomson contributed to Iaryngology throughout the past fifty years.

In 1913, Kerrison produced a Textbook of OtoIogy. This was the best one pubIished in English up to that time. This had much to do with the advance in surgery of the ear.

Shambaugh, with his work on the anatomy of the ear, contributed much to aural surgery.

Barany did much to improve our knowl- edge of Iabyrinthine conditions.

The radica1 operation for chronic sup- purative otitis media was introduced in this country. Unfortunately in the beginning it was done too often, both in this country and abroad. Surgery of the ear and nasal sinuses was too radica1 during the first twenty-five years of this century. At this time far more conservative procedures are in vogue. An understanding of allergic sinusitis has prevented many operations.

216 American Journd of Surgery Dean-OtoIaryngoIogy JANUARY, 1941

Among others Mosher, Jackson and Itard, in 1802, made the first scientifi- SIuder have had much to do with the caIIy Iogical accompIishment in the fieId of deveIopment of otoIaryngoIogy in America auditory stimuIation for the improvement during the past fifty years. Mosher, the of hearing in the deafened chiId with a rhinoIogica1 anatomist and clinician, was remnant of hearing. Toynbee foIIowed in responsibIe for many new surgica1 proce- the footsteps of Itard. Currier, in New dures on the nose, nasa1 sinuses and neck. York, and GiIIespie, at the Nebraska Sluder, the physioIogist, cIarified the sub- SchooI for the Deaf, deveIoped this educa- ject of nasa1 headaches. Jonathan Wright tiona1 procedure during the Iatter part of made great strides in otoIaryngoIogica1 the nineteenth century. pathoIogy. Jackson, the technician, per- In 1893, Urbantschitsch made auricuIar fected instruments and technic that made training practica1. Vienna was at that time bronchoscopy and esophagoscopy so easy the center for graduate teaching of otoIogy that the majority of IaryngoIogists become and many of us worked with Urbant- proficient in this fieId. schitsch. I can remember returning to my

It is impossibIe to mention even the out- clinic and interesting one of the graduate standing otoIaryngoIogists of America dur- students in this subject. She seIected a boy ing the Iast fifty years. Dwyer brought the intubation tube into genera1 use, saving

tweIve years of age, supposed to be deaf,

innumerable Iives. AIIergic study of pa- and using Urbantschitsch’s technic devel-

tients, diatetic treatment, outdoor exercise oped in the boy sufficient hearing to permit

and the use of vaccines produced satisfac- him to enter the pubIic schoo1.

tory resuIts in many otoIaryngoIogica1 Dr. Max GoIdstein worked with Urbant-

cases without resorting to operation. schitsch. With the founding of the Central

The work of Proetz and HiIding has had Institute for the Deaf in St. Louis in 1914,

a nihilistic effect on the use of drugs and he became active in the developing of

sprays in the nose. The treatment of nose, acoustic exercises for the deaf. He has been

throat and ear disease fifty years ago was IargeIy responsibIe for the development of

more or Iess empirica1; today it is based on the science of re-education of the deaf in

a sound physioIogic and pathoIogic basis. this country.

OtoIogists during the Iast fifty years Hudson Makuen, Goldstein and others

were not content to deveIop the pure cIini- deveIoped the science of the correction of

ca1 side of the subject but they made great speech defects. OtoIaryngoIogists during progress in the management of the deafened the past fifty years have done much in the chiId and the correction of speech defects. rehabilitation of the handicapped chiId.